Bruises (cont.)

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

What are symptoms and signs of a bruise, and why does it change color?

Bruises can be associated with tenderness of the involved discolored area. Bruises change in appearance over time, and it may be possible to tell by looking at a bruise how old it is. When it first appears, a bruise will be reddish looking, reflecting the color of the blood in the skin. By one to two days, the reddish iron from the blood undergoes a change and the bruise will appear blue or purple. By day six, the color changes to green and by day eight to nine, the bruise will appear yellowish-brown. In general, the bruised area will be repaired by the body in two to three weeks after which the skin will return to normal.

What if the bruise doesn't get
better or the area stays swollen?

On occasion, instead of going away, the area of a bruise
will become firm and may actually start increasing in size. It may also continue
to be painful. There are two major causes for this. First, if a large collection
of blood is formed under the skin or in the muscle, instead of trying to clean up the area,
the body may wall the blood off causing what is called a hematoma. A hematoma is
nothing more than a small pool of blood that is walled off. This may need to be
drained by your doctor.

A second and much less common problem occurs when the
body deposits calcium, the material that makes up the majority of bone, in the
area of injury. The area becomes tender and firm. This process is called
heterotopic ossification or myositis
ossificans.

This condition is diagnosed by
X-ray and requires a
trip to your
doctor.

What are some less common causes
of bruising, and what do they indicate?

The terminology describing different types of bruising
often refers to not only their appearance but also to their cause.
Petechiae
are 1- to 3-millimeter accumulations of blood beneath the skin. These
can appear like multiple tiny red dots on any part of the body (most commonly
the legs). Most often these are multiple, and they can suggest that there is
serious health problem present. Examples of these are an infection of
the valves of the heart (endocarditis) or
abnormal function of the blood-clotting elements (platelets). Bruising around
the navel (belly button) can be a result of bleeding within the abdomen.
Bruising behind the ear (Battle's sign) can indicate that there is a skull fracture.
Also, bruises that are raised, firm, multiple,
and occur without any injury can be a sign of various types of
"autoimmune" diseases (diseases in which the body attacks
its own blood vessels). Each of these should be evaluated by a doctor.